天津市细颗粒物短期暴露对慢性心力衰竭患者心力衰竭加重再入院的影响及易感人群的探索  

Effect of Short-Term Exposure to PM2.5 in Tianjin on Readmission of Patients with Chronic Heart Failure and Exploration of Susceptible Population

作　　者：邢璐宇 陈欣[2] 孙洁 XING Luyu;CHEN Xin;SUN Jie(The First Central Clinical College of Tianjin Medical University,Tianjin 300110,China;Cardiology Department,Tianjin First Central Hospital,Tianjin 300110,China)

机构地区：[1]天津医科大学一中心临床学院,天津300110 [2]天津市第一中心医院心脏科,天津300110

出　　处：《心血管病学进展》2022年第9期846-851,共6页Advances in Cardiovascular Diseases

基　　金：天津市气象局科研项目(202003zdxm02)。

摘　　要：目的分析天津市大气污染物细颗粒物(PM_(2.5))短期暴露对慢性心力衰竭(心衰)患者心衰加重再入院的影响以及是否存在易感人群。方法收集2018年1月1日—2020年12月31日天津市第一中心医院心脏科每日因心衰入院患者的病历资料,根据纳入和排除标准确定研究对象;收集同期天津市区污染物及气象数据,采用时间分层的病例交叉研究方法比较不同滞后天数(lag0~7)下,天津市PM_(2.5)短期暴露对慢性心衰患者心衰加重再入院的影响以及易感人群特征。结果研究共纳入1167例次慢性心衰患者。单污染物模型中,在控制气象混杂因素的情况下,PM_(2.5)短期暴露可导致慢性心衰患者因心衰加重再入院的风险增加,大气PM_(2.5)浓度每升高10μg/m^(3),慢性心衰加重的再入院风险在lag0、lag2、lag3、lag4、lag5均增加(P<0.05),其中最佳滞后期为lag0(OR=1.0298,95%CI 1.0046~1.0556)。在多污染物模型中,PM_(2.5)+可吸入颗粒物(PM_(10))、PM_(2.5)+一氧化碳并未增加患者心衰加重再入院的风险。在控制混杂因素的情况下,当PM_(2.5)浓度每升高10μg/m 3,年龄≥65岁、既往合并高血压、肺部感染、心衰病因为血管性心脏病的患者更易发生心衰加重再入院。结论PM_(2.5)短期暴露会增加慢性心衰患者心衰加重再入院风险,老年人、既往合并高血压、肺部感染以及心衰病因为血管性心脏病的患者更易感。Objective To analyze the effect of short-term exposure of air pollutant PM_(2.5) in Tianjin on the readmission of patients with chronic heart failure and whether there is a susceptible population.Methods From January 1,2018 to December 31,2020,the medical records of patients admitted to hospital for heart failure in Cardiology Department,Tianjin First Central Hospital were collected,and the subjects were determined according to the inclusion and exclusion criteria.At the same time,the pollutants and meteorological data of Tianjin were collected,and the effects of short-term exposure of PM_(2.5) on the readmission of patients with chronic heart failure and the characteristics of susceptible population were compared under different lag days(lag0~7)by time-stratified case-control study.Results A total of 1167 cases with chronic heart failure were included in the study.In the single pollutant model,under the control of meteorological confounding factors,short-term exposure to PM_(2.5) can increase the risk of readmission of chronic heart failure patients due to worsening heart failure.Every 10μg/m^(3) increase in atmospheric PM_(2.5) concentration,the readmission risk of chronic heart failure exacerbation increased in lag0,lag2,Lag3,lag4 and lag5(P<0.05),and the best lag period was lag0(OR=1.0298,95%CI 1.0046~1.0556).In the multi-pollutant model,PM_(2.5)+PM_(10) and PM_(2.5)+CO did not increase the risk of heart failure aggravating readmission.When the PM_(2.5) concentration increased by 10μg/m 3,patients≥65 years old,with previous hypertension,pulmonary infection,and heart failure due to vascular heart disease are more likely to suffer from worsening heart failure and be readmitted in the case of controlling the confounding factors.Conclusion Short-term exposure to PM_(2.5) increases the risk of readmission in patients with chronic heart failure.The elderly,patients with previous hypertension,pulmonary infection and heart failure due to vascular heart disease are more susceptible.

关 键 词：细颗粒物 心力衰竭 易感人群 

分 类 号：R541.6[医药卫生—心血管疾病]